Questions & Answers
Anthrax - The Anthrax Vaccine
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Mail Handling Safety

  1. How can mail get cross-contaminated with anthrax?
    CDC does not have specific studies to address this, however, cross-contamination of the mail could occur during the processing, sorting, and delivery of mail when an envelope comes in contact with an envelope, piece of equipment (e.g., an electronic sorting machine), or other surface that is contaminated with Bacillus anthracis spores. In addition, airborne spores in contaminated postal facilities before they were cleaned might play a role.

  2. When there is a known incident, how can I prevent anthrax exposure from cross-contaminated mail?
    There are no scientifically proven recommendations for preventing exposure. However, there are some common-sense steps people can take:
    • Do not open suspicious mail
    • Keep mail away from your face when you open it
    • Do not blow or sniff mail or mail contents
    • Avoid vigorous handling of mail, such as tearing or shredding
    • Wash your hands after handling the mail
    • Discard envelopes after opening mail.

  3. What should people do when they get a letter or package with powder?
    Handling of Suspicious Packages or Envelopes:
    • Do not shake or empty the contents of any suspicious package or envelope.
    • Do not carry the package or envelope, show it to others or allow others to examine it.
    • Put the package or envelope down on a stable surface; do not sniff, touch, taste, or look closely at it or at any contents which may have spilled.
    • Alert others in the area about the suspicious package or envelope. Leave the area, close any doors, and take actions to prevent others from entering the area. If possible, shut off the ventilation system.
    • WASH hands with soap and water to prevent spreading potentially infectious material to face or skin. Seek additional instructions for exposed or potentially exposed persons.
    • If at work, notify a supervisor, a security officer, or a law enforcement official. If at home, contact the local law enforcement agency.
    • If possible, create a list of persons who were in the room or area when this suspicious letter or package was recognized and a list of persons who also may have handled this package or letter. Give this list to both the local public health authorities and law enforcement officials.
    These recommendations were published on October 26, 2001, in “Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy” MMWR 2001; 50(42):909-919.

  4. What is the risk for getting anthrax from handling my own mail?
    If there is a risk for inhalational anthrax associated with exposure to cross-contaminated mail, it is very low. For example, about 85 million pieces of mail were processed on the few days in 2001 after envelopes containing Bacillus anthracis (addressed to two U.S. senators) passed through the New Jersey and District of Columbia sorting facilities until they were closed. Despite the fact that both of these facilities had evidence of widespread environmental contamination with B. anthracis spores and the fact that public health officials had been aggressively looking for anthrax cases, no new cases of anthrax were identified during that time.

  5. When the possibility of cross-contamination of the mail exists, should I take antibiotics?
    Preventive antibiotics are not recommended for persons who routinely open or handle mail, either at home or at the workplace. Antimicrobial prophylaxis is recommended only in certain specific situations such as for persons exposed to an air space known to be contaminated with aerosolized Bacillus anthracis or for persons in a postal sorting facility in which an envelope containing B. anthracis spores was processed. CDC's complete recommendations on antimicrobial prophylaxis are contained in the November 9, 2001 MMWR. Additional recommendations for use of vaccine as part of post-exposure prophylaxis are contained in the November 15, 2002 MMWR 51(45):1024-1026.

  6. What kinds of anthrax worker safety guidelines have been issued?
    The recommendations are divided into four categories. They are engineering controls, administrative controls, housekeeping controls, and personal protective equipment for workers. The guidelines describe measures that should be implemented in mail-handling/processing sites to prevent potential exposures to B. anthracis spores.